RESUMO
BACKGROUND: There is a high morbidity rate after digestive surgery in patients with nutritional disorders such as high body mass index and depletion of skeletal muscle. MATERIALS AND METHODS: The ratio of psoas muscle area to trunk area was defined as the Psoas and All trunk Ratio (PandA Ratio) and used as an index of the balance between muscle and adipose tissue. This ratio was determined in 77 patients undergoing laparoscopy-assisted gastrectomy (LAG) for gastric cancer. Patients were classified into groups with and without postoperative complications. Clinicopathological factors were compared between the groups, and relationships of PandA Ratio with other nutritional indices were examined. PandA Ratios were also analyzed in males and females in each Clavien-Dindo grade. RESULTS: Complications developed in 22 patients (28.6%) after LAG. The PandA Ratio was significantly lower in patients with complications in univariate (2.76 ± 0.22% versus 3.66 ± 0.14%, P = 0.0009) and multivariate (P = 0.0064) analyses. A low PandA Ratio was also associated with more severe complications in males. CONCLUSIONS: Measurement of the areas of the psoas muscle and trunk on CT is useful for evaluation of the balance between skeletal and adipose tissue. The PandA Ratio derived from these measurements is a predictor of the clinical course after LAG in males.
Assuntos
Composição Corporal , Gastrectomia , Laparoscopia , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adiposidade , Adulto , Idoso , Feminino , Gastrectomia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Músculos Psoas/anatomia & histologia , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Tórax/anatomia & histologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Nutritional status influences cancer prognosis. Measurement of the area of the psoas muscle on computed tomography is useful for evaluation of skeletal muscle mass and prediction of prognosis. PATIENTS AND METHODS: The psoas muscle index (PMI) was determined in 42 patients undergoing surgery for stage 4 colorectal cancer. Patients were classified into high and low PMI groups using a cutoff of 5.5×10-4 cm2 m-2 Relationships of PMI with prognosis, chemotherapy period, and postoperative complications were examined. RESULTS: The 3-year overall survival rate was 24.0%. PMI was significantly associated with 3-year OS in univariate (high vs. low PMI: 43.0% vs. 12.9%, p=0.0415) and multivariate (p=0.0146) analyses. A low PMI was associated with a shorter period of chemotherapy. A reduction in PMI was a predictor of a poor prognosis. CONCLUSION: PMI status is related to the period of chemotherapy and is an independent prognostic factor in patients with stage 4 colorectal cancer.
Assuntos
Neoplasias Colorretais/cirurgia , Avaliação Nutricional , Estado Nutricional , Músculos Psoas/patologia , Idoso , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Tamanho do Órgão , Avaliação de Resultados em Cuidados de Saúde/métodos , PrognósticoRESUMO
Although esophageal reconstruction using the stomach is common in surgery for esophageal cancer, this procedure sometimes results in delayed gastric emptying and reflux. This is a case report of reoperation for intractable obstruction of the stomach after initial esophageal surgery in a 59-year-old man. The obstruction was resistant to conservative management. We resected the duodenum, preserving the vascular pedicle of the right gastroepiploic vessels, and performed reconstruction with a Roux-en-Y procedure in the second operation. There was marked improvement in gastric emptying.
